Violation of maternal integrity during childbirth: a micro-, meso- and macrostructural perspective. (13th November 2019) - Batram-Zantvoort, S
Abstract: Background: Violation of maternal integrity (VMI) during childbirth is reported by women world-wide and reflects one aspect of gender-related violence against women. Terminology and concepts to describe VMI range from disrespect and abuse over mistreatment in childbirth to obstetric violence. The choice of terms might determine the scope of reference: while mistreatment encompasses rather interactional forms of VMI embedded on a microstructural level of society, obstetric violence includes a critical view on gendered power imbalances and is therefore considering cultural, political and economic exposures situated on macro- and meso-level. To identify different ways of explicitly integrating or implicitly reflecting micro-, meso- and macrostructural dimensions of VMI, we examine terminology, methodology and results in published research. Methods: For our review, we chose a meta-ethnographic approach, viewing studies on VMI as primary data in terms of defining, collecting, describing and analysing the phenomena of VMI. Our goal lies in first determining the explanatory model of each study and second synthesising these findings to outline a multilevel framework on maternal integrity. Findings: Studies predominantly concentrate on interaction-related determinants of VMI. To integrate macro- and mesostructural factors of VMI within a comprehensive framework, further epidemiological research on structural and social determinants of maternal health as well as interdisciplinary collaboration on the intertwining of gender imbalances in health care is needed. Conclusions: By differentiating between macro-to-micro-level factors of VMI, potential causes that go beyond the interaction level (e.g. policy, financial allocation, legal laws, maternal care conditions) can be identified to improve both research and implementation in obstetric care.